Middle-class mothers 'should be talked out of caesareans'

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One in four births in Britain today is now carried out by caesarean, a major operation which costs the NHS thousands of pounds a time.

The rate has more than doubled since 1980, and some research suggests their growing popularity has been driven partly by more affluent mothers demanding them - those who critics say are "too posh to push".

Many obstetricians consider the rate to be too high.

Now the National Institute for Health and Clinical Excellence (Nice) has issued draft guidance saying women who want caesareans simply because they fear giving birth naturally, rather than for a clinical reason, should be made to have a full discussion about their options.

It says the doctor should offer to set up a separate appointment so that the woman's concerns about childbirth can be addressed.

The guidance ... recommends: "When a woman requests a CS [caesarean section] because she has a fear of childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her fears in a supportive manner."

Doctors should "discuss the overall risks and benefits" ... "to ensure the woman has accurate information".

Women should still be able to have caesareans if they do not want to give birth normally ... "If after providing support, a vaginal birth is still not an acceptable option to the woman, offer a planned CS."

... the balance of risks to mother and child between caesarean and natural delivery is "controversial" ...

... while 30 years ago mothers having caesareans "were more likely to come from deprived social backgrounds", by 2000 they were more likely to be from "higher social classes".

... Other research indicates that women rarely actively choose them, and that more than nine in 10 are performed on medical advice ...